iloprost and Vasculitis

Leg ulcers are a recognised manifestation of cutaneous vasculitis in connective tissue diseases (CTDs) including rheumatoid arthritis (RA). Iloprost a stable prostacyclin analogue has been successfully used to treat Raynaud's phenomenon and digital ulcers associated with CTD's. Our aim was to assess iloprost in the treatment of vasculitic leg ulcers in CTD. In this paper we describe eight cases of vasculitic leg ulceration in association with RA and CTD, treated with intravenous iloprost. The iloprost was administered for 6-8 hours daily and continued for 21-28 days. Immunosuppressive therapy was required in three patients with severe necrotising vasculitis (RAnv). Complete ulcer healing was achieved in four patients within 6 weeks of commencing therapy while rapid improvement occurred in the other four patients. This suggests that iloprost may be useful as an adjunct to therapy for vasculitic leg ulcers. A double-blind placebo controlled study of iloprost therapy for RA leg ulcers is under way.

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Connective Tissue Diseases; Drug Administration Schedule; Female; Humans; Iloprost; Immunosuppressive Agents; Infusions, Intravenous; Leg Ulcer; Male; Middle Aged; Treatment Outcome; Vasculitis

A patient with digital ischaemia and gangrene was treated with iloprost and antiplatelets for two weeks. His vasculitic screen was negative except for a positive HIV test. His vasculitis improved three weeks after treatment with antiretroviral medications. Though vasculitis is well known to be associated with HIV infection, very few cases of HIV present as vasculitis.

Topics: Adult; Aged; Anti-Retroviral Agents; Female; Fingers; Gangrene; HIV Infections; Humans; Iloprost; Male; Treatment Outcome; Vasculitis

Topics: Adolescent; Female; Fingers; Humans; Iloprost; Meningococcal Infections; Sepsis; Treatment Outcome; Vasculitis; Vasodilator Agents

Extra-meningeal and non-cutaneous manifestations of meningococcal infection are well recognized but rare. Herein we report a little recognized complication of meningococcaemia, namely late-onset gastrointestinal vasculitis. In the case presented, the prostacycline analogue iloprost was used in an attempt to minimize incipient digital gangrene ina patient with evidence of protracted immunological phenomena. In addition, diclofenac was used to treat severe arthralgia. Withdrawal of iloprost on day 19 was associated with abdominal pain and peritonism. Laparotomy demonstrated ischaemia and ulceration in the caecum, and histology revealed full thickness mucosal ulceration with a prominent vasculitic process. It is postulated that these findings were immunologically mediated, with possible rebound vasoconstriction following withdrawal of iloprost. It is also possible that NSAID use contributed to the findings via cyto-toxicity to mucosal cells.

Topics: Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Bacteremia; Gastrointestinal Diseases; Humans; Iloprost; Male; Meningococcal Infections; Neisseria meningitidis; Platelet Aggregation Inhibitors; Time Factors; Vasculitis; Vasodilator Agents

Adhesion molecules mediate the interaction between endothelium and platelets as well as other blood cells and the endothelium. The structure and function of some of these molecules will be reviewed and discussed. The expression of these molecules is largely affected by disease states such as hypertension, diabetes, and cardiac failure. Determination of adhesion molecules expressed on the surface of endothelial cells and platelets by cytoflowmetry enables a new approach to estimate the activity state of these cells and might be helpful to identify patients with an increased thrombotic risk.

Topics: Blood Platelets; Cell Adhesion Molecules; Endothelium, Vascular; Humans; Iloprost; Membrane Glycoproteins; P-Selectin; Platelet Membrane Glycoproteins; Risk Factors; Thrombosis; Thrombospondins; Vasculitis

The authors have evaluated the effects of long-term treatment of digital vasculitis secondary to various types of connective tissue disease, Systemic Lupus Erythematosus (SLE), Progressive Systemic Sclerosis (PSS), Sjögren's Syndrome (SS), using iloprost. The drug has proven to be effective both in reducing pain and clinical symptoms induced by vasospastic phenomena, as well as in promoting the healing of serious acral ischemic lesions. In the patient with LES, clinical modifications of the local vasculitic phenomena have been associated with a contemporaneous remission of the disease. The persistence of the drug's clinical effects even after suspension of treatment, instrumental and biohumoral changes and concomitant systemic effects on the disease lead to the conclusion that the drug's effect, is not merely due its vasodilating action and its ability to interfere with the coagulative process, but rather must be sought within the context of a morpho-structural repair of the microcirculation.

Topics: Adult; Aged; Connective Tissue Diseases; Drug Tolerance; Female; Fingers; Humans; Iloprost; Middle Aged; Raynaud Disease; Vasculitis